Surgery of deformities of the face : including cleft palate / by John B. Roberts.

  • Roberts, John B. (John Bingham), 1852-1924.
Date:
1912
Catalogue details

Licence: Public Domain Mark

Credit: Surgery of deformities of the face : including cleft palate / by John B. Roberts. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    In cases of unusual difference in the size of the eyeballs, because one eye is congenitally too small, some cosmetic improvement may be made by lessening the palpebral aperture of the larger organ by tarsorrhaphy and increasing that of the other by a canthoplasty. When, exophthalmos remains after partial or nearly complete recovery from Graves's disease the staring eyes can be greatly improved cosmetically by suturing the edges of the outer canthus and thus diminishing the excessive size of the opening between the lids. In enophthalmos, due to fracture of the orbital bones with sinking of the eyeball, the other eye may be made to correspond in size by suturing the outer canthus. The noticeable lack of cosmetic symmetry may be thus remedied easily and without risk. It is perhaps possible that some improvement might be made in congenital absence of the globe of the eye by plastic and prosthetic surgery. A blind eyeball, which is unsightly from staphyloma or which does not permit a glass eye to be worn over it, may be removed entirely by the operation called enucleation. As has been previously stated staphylomatous corneas may be made satisfactory as to comeliness by removing the anterior section of the ball and adjusting a glass shell to the stump. Instead of entirely removing the eyeball, by cutting its muscles, the optic nerve and the connective tissue about it, the operation of evisceration may be performed. This procedure removes the anterior part of the eye, as in ampu- tation of a staphylomatous cornea, but in addition scoops or wipes out of the containing sclera the iris, ciliary body, choroid, retina and vessels, leaving a perfectly clean and aseptic sclerotic cup. As this posterior scleral section has the extrinsic muscles of the globe attached to it and partially fills the cavity of the orbit, the artificial eye worn over it fills out the space under the eyelids quite well and has a great deal of mobility. The cosmetic gain is therefore great compared with that obtained when using a glass shell after an enucleation. Then the stump is too small to fill up the cavity formerly occupied by the eye- ball and the upper eyelid drops back into the orbit. This causes an unnatural hollow under the eyebrow. A still better stump for the adaptation of an artificial eye shell is secured by introducing into the eviscerated sclerotic a ball of gold, glass or paraffin, which being aseptic remains enclosed within the sclerotic of the eye for years without causing disturbance. The stump thus distended makes, when covered with a glass shell, an almost perfect companion for the normal eye of the other side. The arti- ficial vitreous body within the scleral cup makes a mass nearly the